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Can the Surgical Apgar Score predict morbidity and mortality in general orthopaedic surgery?

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Abstract

Purpose

The Surgical Apgar Score (SAS) is a simple tally based on intra-operative heart rate, blood pressure and blood loss; it predicts 30-day major postoperative complications and mortality in different surgical fields, but no validation has been performed in general orthopaedic surgery.

Methods

A prospective assessment of the SAS in 723 consecutive patients undergoing major and intermediate orthopaedic procedures was performed in an 18-month period. The SAS was calculated immediately after surgery, and the occurrence of major complications or death was registered within a 30-day follow-up.

Results

Thirty-seven patients had ≥1 complication (5.12 %). The complication rate did not augment as the score decreased (SAS 9–10 = 6.56 %; SAS 7–8 = 2.62 %; SAS 5–6 = 7.21 %; SAS ≤4 = 10.2 %), the relative risk did not augment as the score decreased and the likelihood ratio did not increase with decreasing SAS values, except in the subgroup of patients undergoing spine surgery. The C-statistic was 0.59 (95 % confidence interval 0.48–0.69), a weak discriminatory value. Using a threshold of 7 to define high-risk and low-risk patients, the SAS allowed risk stratification only for spine surgery.

Conclusions

The SAS does not predict 30-day major complications and death in patients undergoing general orthopaedic surgery, but it is useful in the subgroup of patients undergoing spine surgery.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile

    Julio Urrutia, Macarena Valdes, Tomas Zamora, Valentina Canessa & Jorge Briceno

Authors
  1. Julio Urrutia
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  2. Macarena Valdes
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  3. Tomas Zamora
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  4. Valentina Canessa
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  5. Jorge Briceno
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Correspondence to Julio Urrutia.

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Urrutia, J., Valdes, M., Zamora, T. et al. Can the Surgical Apgar Score predict morbidity and mortality in general orthopaedic surgery?. International Orthopaedics (SICOT) 36, 2571–2576 (2012). https://doi.org/10.1007/s00264-012-1696-1

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  • DOI: https://doi.org/10.1007/s00264-012-1696-1

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